Transcript Stress management 2010 - The Grange School Blogs

PYA2 – Stress
Critical Issue:
Stress Management
Stress Management
BATs
AO1- Distinguish between Problem and
Emotion focussed coping strategies
-Outline psychological and physiological
methods of stress management
AO2 – Compare and evaluate different
methods of stress management
Homework: p155 q3 c (i) and (ii)
Next week – recap of module and 30min mini mock!!
How do you cope with stress?
• In groups brainstorm the ways you use to
cope with different stressful situations
Approaches to coping with stress
• Folkman and Lazarus (1980) –
‘cognitions and behaviours that a person
uses to reduce stress and moderate its
emotional impact.’
• Ways of Coping Questionnaire – found
2 ways people cope
• Problem – focused coping
• Emotion-focused coping
Coping response varies with type of stressor
Problem - focused Coping
Stress is treated as a problem to
be solved.
• Seeking social support – discussing a
problem helps make more sense of it, puts
problem in perspective.
• Taking control – e.g taking steps to deal with
debt, finding out about a disease, looking for
a new job.
Problem Focused Coping
• Evaluating the pros and cons of different ways
of dealing with the stress – e.g. planning a new
life after bereavement, choosing whether to have
surgery,
• Suppressing competing activities – e.g.
avoiding the temptation to put off going to the
dentist because of work commitments
• Anticipatory coping – work out what triggers
stress, train ourselves to anticipate and deal with
it e.g working out your route to a new location,
anticipating possible roads to avoid e.t.c
Problem Focused Coping
These strategies are often achieved
through Psychological Therapies
• Cognitive Behavioural Therapy – CBT
Emotion – focused Coping
Avoidant methods, used when a person feels
there
is nothing that can be done to change the problem.
Treats the symptoms not the problem
1. Defence mechanisms – tend to be negative
• Denial – e.g going on as if nothing has
happened
• Distancing/distraction – e.g just not thinking
about it, See Lee et al p 146
• Focusing on and venting emotions e.g crying,
anger, praying (seeking guidance and strength +ve)
• Wishful thinking – dwelling on what might have
been if this hadn’t happened
Emotion – focused Coping
2. Reappraisal/reinterpreting – taking
another look at the situation may change
the way you feel about it. A positive
approach.
3. Arousal reduction – heightened
reactions associated with stress are
reduced, so the person becomes less
stressed e.g meditation, relaxation,
exercise, biofeedback or drug therapy
Gender differences in coping
• Do you think males and females may cope
differently? 2 mins
• Research has evidence that ..
• Males more likely to use Problem-focused
methods, whereas women use emotionfocused (Brady and Hall, 93)
Gender differences in coping
• Rosario (88) – 2 theories to explain this..
1. Socialisation theory – women taught to
show emotions openly, men taught to
approach stress in a more active way.
2. Role constraint theory – coping strategy
matches roles males and females occupy.
When males and females
have same role – used same
strategies to cope with stress
Can you distinguish between Emotion
and Problem focused coping?
• Look back at the coping strategies you put
on the brainstorm
• Decide whether each is an example of
problem-focused or emotion-focused.
Plenary
1. Explain the difference between problemfocused and emotion-focused
approaches to coping with stress.
2. For each approach give 2 examples and
provide a piece of research evidence.
(see pages 145-148)
3. Describe 2 strengths and weaknesses of
each approach.
There is a very, very tall coconut tree,
and there are 4 animals passing by:
King Kong, Ape, Orangutan and Monkey
They have a competition to see who is
the fastest to get the banana. Who do
you guess will win?
Your answer will reflect your
personality. Try and answer within 30
seconds
Got your answer?
If your answer is ....
Orangutan = Dumb
Ape = Foolish
Monkey = Idiotic
King Kong = Stupid
Why ?????
A Coconut tree ........ doesn't have bananas!!
It's obvious you're stressed by your work.
Go home!
What is Stress Management?
The process by which an
individual attempts to cope with
(manage) stressful demands.
• Psychological – CBT (e.g Stress
Inoculation, Hardiness training and
REBT)
• Physiological – Drug therapy,
Biofeedback, exercise
Psychological Methods
• Use techniques that help the person
cope with the situation itself rather
than just dealing with the symptoms.
• Patients find ways of changing or
avoiding stressful situations in the
future.
• Or learn techniques to minimise
negative effects of stressful
situations
Psychological Methods
• Rational Emotive Behaviour Therapy
(REBT)
• Cognitive Behaviour Therapy (CBT)
• SIT
• Hardiness Training
Pages
148-50
Over to you…
You have
30
minutes
• In pairs or small groups you will be given one
method of Psychological stress management to
research.
• The aim is to produce a fact sheet that..
• Outline the method
• Studies/research that support the method
• Studies/research that challenge the method
• Strengths and weaknesses
• The fact sheet will then be photocopied and
used by the class for essay construction and
revision, and each method discussed and
evaluated.
Psychological Methods
Stress Inoculation Training (SIT)
Meichenbaum (1985) – cognitivebehavioural therapy – person can change way
they think about certain stressors.
Suggested client should develop a form of
coping before the problem arises – inoculate
yourself against the disease of stress like
vaccinations to prevent infectious diseases!
Use clients’ existing coping skills.
Stress Inoculation Training
(SIT)
Meichenbaum (1985) – 3 stages:
1. Conceptualisation –
Therapist and client establish a
relationship. Client taught to perceive
threats as problems-to-be-solved.
Stressors broken down into specific
components that can be coped with.
Thus helped to gain greater
understanding of the nature of stress
and their reactions to it.
Stress Inoculation Training
(SIT)
Meichenbaum (1985) – 3 stages:
2. Skills Training and Practice
Client taught strategies to cope with stressful
situations tailored to needs of client. E.g
positive thinking, relaxation, social skills,
ways of diverting attention, using social
support systems, time management.
Use of coping self statements (see p112) encourage client to think in a different way
(cognitive) and involves conditioning
(behavioural).
Stress Inoculation Training
(SIT)
Meichenbaum (1985) – 3 stages:
3. Real-life Application (and follow through)
Client goes out into the real world and puts
training to the test in different situations,
which become increasingly stressful.
Techniques include – imagery, modelling and
role playing and training others.
Booster sessions offered later on (follow
through)
The reinforcement of successful coping in the
real world becomes self sustaining.
Evaluation of Research
Strengths
Weaknesses
• It works! –Meichenbaum
(1996) successful with
acute and chronic stress.
• Combines cognitive and
behavioural therapy –
powerful method of stress
management
• By gaining new skills gap
between demands and
coping resources narrows
– more confidence in
handling previously
stressful situations
• Time consuming and high
levels of motivation
needed –only suits a small
range of determined
individuals. Expensive.
• Difficult to change some
behaviour
• Complex – may not need to
do all aspects of the
therapy – e.g. may be
sufficient to just talk
more positively and relax
more
Other supporting research
Meichenbaum (1977)
Compared SIT with another therapy – desensitisation to
help clients with phobia of snakes. Both methods
helped, but SIT better because helped them cope
with other phobias too.
Fontana et al (1999) - College students had lower heart
rates and state anxiety levels than controls – this was
also case 6 months later.
Jay and Elliott (1990) – Parents of children undergoing
medical procedures. The SIT group reported less
anxiety than group observing their children in a
cognitive therapy programme.
Psychological Method 2:
Hardiness Training
Kobasa and Maddi (1977)
If some people are naturally resistant to
stress (hardy personality), may be possible to
teach others how to be ‘hardier’ and thus
manage stress better.
Suzanne Kobasa and Salvator Maddi founded
Hardiness Institute in California.
Aim of training programme is to increase
confidence and sense of control to deal more
successfully with change.
Psychological Method 2:
Hardiness Training
Kobasa and Maddi (1977)
1.Focusing – client taught to spot signs of
stress (e.g. muscle tension, increased heart
rate, anxiety). Allows client to recognise
stressful situations and thus sources of
stress.
2.Reliving Stress Encounters – clients analyse
recent stressful situations in terms of how
easily they were resolved and how they might
have turned out better or worse. Gives client
insight into their current coping strategies
and how they might be better than they
thought.
Psychological Method 2:
Hardiness Training
Kobasa and Maddi (1977)
3. Self-improvement – The key to
hardiness is the belief that we can cope
with life’s challenges.
Client taught to focus on seeing
stressors as challenges and thus learn
to take control.
Control, commitment and challenge are
the basis of hardiness training.
Evaluation of Hardiness Training
Strengths
• Deals with the problem
rather than the
symptoms – teaches
clients to manage all
stressors in their life.
• More adaptable and
effective than drugs
• Long-term
effectiveness
Weaknesses
• Much of research
carried out on male
executives or soldiers in
US. Low ecological
validity.
• High control can be
stress inducing for
some people.
• Difficult to modify
learned habits.
• Does hardiness exist? –
is it just being in
control?
Other Research on Hardiness
 Fletcher (2005) – hardiness training
effectively used on Olympic swimmers
to ensure they are committed to
challenge of increased performance
levels and able to control stressful
aspects of their daily lives that might
interfere with training.
 Funk (1992) argues that low hardiness is the same as
being negative, and it is negativity not lack of hardiness
that leads to the ill effects of stress.
Comparison of SIT and
Hardiness Training
•
•
•
Both treat the
problem not the
symptoms.
Both teach clients
skills to provide
lasting and varied
strategies to cope
with stress
Both teach clients
to view stress as a
problem to be
solved
• Both require
lengthy training and
highly motivated
clients.
• The success of SIT
may be mainly due
to positive thinking
• The success of
hardiness training
may be due to
increased control
Presentation
• Each group needs to briefly outline what
they have found out about their method of
stress management.
• 5 mins max each please
• Hand in sheet for photocopying
Plenary
• Overall what are the advantages of
Psychological methods of stress
management?
• Overall what are the disadvantages?
• Are these methods problem-focused or
emotion focused? Give a reason for your
answer.
Physiological approaches to
stress management
These methods focus
on getting rid of the
emotions associated
with the stressful
situation, but the
situation may not be
changed.
They directly target
the stress- response
systems.
Anxiolytic* Drug Therapy
Benzodiazepines (BZ’s)
Librium, Valium, Halcion, Xanax
Short term relief of severe anxiety.
1.Enhance action of natural brain chemical, GABA.
2. GABA tells neurons to slow down or stop firing
– general quietening influence on brain.
3. Action of GABA is supported by BZ’s to
inhibit neuron activity even more
4. The brain’s output of excitatory
neurotransmitters (e.g serotonin) is reduced
and person feels calmer
Anxiolytic – anti-anxiety drugs, GABA – gamma-amino-butyric acid
Anxiolytic* Drug Therapy
Beta-blockers
Treat high blood pressure
1. Reduce activity of adrenaline and
noradrenaline, which are key agents in
sympathetic (ANS) arousal.
2. By blocking ANS arousal, beta-blockers slow
the heart beat, lessen the force with which
the heart contracts and reduces blood vessel
contraction.
3. This results in a fall in blood pressure and
less stress on the heart.
Also given to sportsmen and women to reduce
arousal which can affect performance
negatively.
Anxiolytic* Drug Therapy
1.What do you think are the
advantages and disadvantages of
using drug therapy to manage
stress.
2. Do these methods really manage
the stress? Explain.
SSRI’s
•
•
•
•
•
Selective Serotonin Reuptake Inhibitors
E.g Prozac
Prevent the recycling of Seratonin
Leads to more Seratonin in the synapses
Helps depression as people suffering this illness
have low levels of Seratonin.
Trivedi et al 2006 – 3000 depressed patients given
Citalopram. 47% halved their depression score.
BUT -Effectiveness did depend on type of
person.
See p151 Exploring
Psychology
Evaluation of Drug Therapy
Strengths
•
High efficacy (work on
range of anxiety disorders)
Kahn et al (1986) – BZs
superior to placebo
•
Work quickly to reduce
disabling effects of stress
related anxiety.
•
Low toxicity
•
Rai et al (2005) – Beta
Blockers increased survival
of patients with certain
serious heart problems.
•
Can be prescribed
immediately for acute
stress
•
Easy to take
Weaknesses
•
Addictive –BZs
psychological and physical
dependence can develop
within a few weeks – Ashton
1997 – BZs limited to 4
weeks use
•
Side effects – drowsiness,
•
dizziness, tiredness, dry mouth,
diarrhoea, changes in sex
drive/ability, seizures, severe
skin rash, irregular heartbeat
Can prevent normal
psychological adjustment –
treats the symptoms not
the problem
Time to relax!!
•
•
•
•
•
•
Measure your pulse. Jot it down.
You may use a biodot.
Now lie down and get comfortable
Listen to the CD.
R E LLAA AX !
Now retake your pulse and look at your
biodot
• Any change?
Biofeedback
Person learns to exert voluntary control over
involuntary (autonomic) behaviours
Biofeedback involves 4 processes:
• Feedback – patient attached to machines
that give feedback about ANS activities –
heartbeat, blood pressure
• Relaxation – patient taught relaxation
techniques – reduces activity of sympathetic
nervous system and activates
parasympathetic NS – reduced heart rate,
blood pressure and symptoms related to
stress
Biofeedback
• Operant conditioning – relaxation leads to
target behaviour e.g. reduced heart rate,
which is rewarding.
• This will increase likelihood of same
behaviour being repeated. This learning
(conditioning) takes place without conscious
thought.
• The reward results in an unconscious
‘stamping in’ of the behaviour. (Like Pavlov’s
dogs)
• Transfer – The patient transfers the
skills learned to everyday situations.
Research on Biofeedback
 Budzynski et al (1973) Biofeedback and
tension headache
See p 152 of text book
This would be a good example to learn
and use in essays and other answers
about stress management
 How effective was the
biofeedback on relieving the
headaches?
Research on Biofeedback
 Miller and DiCara (1967) – paralysed 24 rats, kept
alive by artificial respiration. Half rewarded when
heart rate slowed down, other half rewarded when
heart rate went up – reward was to stimulate pleasure
centre in brain. ‘Fast’ group speeded up heart rate,
‘slow’ group slowed down. Learning was involuntary
and ANS responses were conditioned as a result of
operant conditioning.
Explanations – Is it operant conditioning which provides the
biofeedback or simply learning to relax?
Alternatively this method may make patients feel more in
control, producing beneficial effects – remember lack of
control thought to be a source of stress
Other supporting research includes Gruber and Taub (1998)
and Attanasio et al (1985)
Evaluation of Biofeedback
•
•
•
Strengths
Non-invasive
No negative side
effects
Provides patient
with long lasting
means of dealing
with stress
symptoms
Weaknesses
• Expensive –the cost
of equipment and
time needed
• Treating the
symptoms not the
problem – does not
treat the source of
stress
Plenary
1. Which do you think is a more effective
way of managing stress, drug therapy
of biofeedback? Why?
2. Which is best Emotion-focused or
problem-focused methods?
Why?
3. Which is best Emotion-focused or
problem-focused methods?
•
•
•
•
•
•
Problem-focused
Aim to remove
problem
No side effects
Last longer
Slower
More expensive
Ppts need to be
motivated to stick with
them
•
•
•
•
•
•
Emotion focused
Control symptoms –
problem still there
Quick and effective
Relatively cheap
May have side effects
May cause addiction
Biofeedback – no
addiction or side
effects, more
expensive than drugs
Homework
• Homework: p155 q3 c (i) and (ii)
• Next week – recap of module and 30min
mini mock!!
• So REVISE!!!!